Prevention of secondary caries using silver diamine fluoride treatment and casein phosphopeptide-amorphous calcium phosphate modified glass-ionomer cement

Abstract

Objective: To study the effect of silver diamine fluoride (SDF) treatment and incorporating casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) into a glass-ionomer cement (GIC) to prevent secondary caries. Method: A cervical cavity was prepared on 32 premolars for the following restoration groups: group 1, conventional GIC restoration; group 2, SDF (38%) treatment and conventional GIC restoration; group 3, CPP-ACP (3%) modified GIC; and group 4, SDF treatment and CPP-ACP modified GIC. The restored teeth were thermal-cycled before undergoing a multi-species cariogenic biofilm challenge. The restored teeth were examined by micro-computed tomography (micro-CT), scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM/EDX) and Fourier transform infrared (FTIR) spectroscopy. Data were analyzed by two-way ANOVA. Results: Micro-CT determined outer lesion depths for groups 1–4 were: 123 ± 6 μm, 87 ± 7 μm, 79 ± 3 μm and 68 ± 5 μm respectively. An interaction effect on the outer lesion depth was found between the restorative materials and SDF treatment (p < 0.001). Both SDF treatment and modification with CPP-ACP had a significant effect on outer lesion depth (p < 0.001). SEM/EDX showed an increase of calcium and phosphorus at the root dentine adjacent to the restoration in groups 3 and 4 (CPP-ACP modified GIC). FTIR revealed that SDF treatment and CPP-ACP modified GIC had a significant effect on amide I-to-hydrogen phosphate ratio on the material-root interface (p = 0.001). Conclusion: SDF treatment and incorporation of CPP-ACP into GIC restorative material can prevent secondary root caries development. Clinical significance: The results provide useful information to dentists in formulating clinical management protocols and material when treating root caries.